Hospital Utilization in Ambulatory Patients With COVID-19 With History of Tobacco Use

Tobacco use is a risk factor for COVID-19 severity. This study explores an association between tobacco use and COVID-19-linked all-cause healthcare utilization in ambulatory patients.

Among 49,588 University of Maryland Medical System patients who tested positive for COVID-19 between February 1, 2020, and October 31, 2021, 20,621 ambulatory patients at first presentation were analyzed using a cross-sectional study. A multinomial multivariable logistic regression model was used to test the impact of tobacco use on hospital and emergency department utilization, with COVID-19 severity, comorbid diagnoses, obesity, chronic steroid use, sex, race, age, and Social Vulnerability Index included as covariates.

Of the 20,621 patients, 2,030 (9.84%) were current users; 4,586 (22.24%) were former users; and 14,005 (67.92%) never used tobacco. A total of 16,518 (80.10%) patients remained ambulatory during their COVID-19 illness; 1,786 (8.66%) utilized the emergency department; and 2,317 (11.24%) were admitted to the hospital. Both former (AOR=1.286; 95% CI=1.132, 1.462; p=0.0001) and current (AOR=1.450; 95% CI=1.246, 1.689; p<0.0001) tobacco users were more likely to visit the emergency department than never users. However, only former users were significantly more likely to be hospitalized than never users (AOR=1.320; 95% CI=1.187, 1.468; p<0.0001).

Tobacco users with COVID-19 are more likely to have increased healthcare utilization than never users, with current users more likely to use the emergency department and former users more likely to utilize the hospital. Ambulatory patients who use tobacco should receive closer COVID-19 quarantine management to prevent severe outcomes and healthcare overutilization.